Evidence-based clinical practice guidelines on the management of pain in older people – a summary report

Objective:The objective of this study is to develop an update of the evidence-based guidelines for the management of pain in older people.Design:Review of evidence since 2010 using a systematic and consensus approach is performed.Results:Recognition of the type of pain and routine assessment of pain should inform the use of specific environmental, behavioural and pharmacological interventions. Individualised care plans and analgesic protocols for specific clinical situations, patients and health care settings can be developed from these guidelines.Conclusion:Management of pain must be considered as an important component of the health care provided to all people, regardless of their chronological age or severity of illness. By clearly outlining areas where evidence is not available, these guidelines may also stimulate further research. To use the recommended therapeutic approaches, clinicians must be familiar with adverse effects of treatment and the potential for drug interactions

Mental Stress Provokes Ischemia in Coronary Artery Disease Subjects Without Exercise- or Adenosine-Induced Ischemia

ObjectivesThe purpose of this study was to investigate the possibility that some patients with coronary artery disease (CAD) but negative exercise or chemical stress test results might have mental stress-induced ischemia. The study population consisted solely of those with negative test results.BackgroundMental stress-induced ischemia has been reported in 20% to 70% of CAD subjects with exercise-induced ischemia. Because mechanisms of exercise and mental stress-induced ischemia may differ, we studied whether mental stress would produce ischemia in a proportion of subjects with CAD who have no inducible ischemia with exercise or pharmacologic tests.MethodsTwenty-one subjects (14 men, 7 women) with a mean age of 67 years and with a documented history of CAD were studied. All subjects had a recent negative nuclear stress test result (exercise or chemical). Subjects completed a speaking task involving role playing a difficult interpersonal situation. A total of 30 mCi 99mTc-sestamibi was injected at one minute into the speech, and imaging was started 40 min later. A resting image obtained within one week was compared with the stress image. Images were analyzed for number and severity of perfusion defects. The summed difference score based on the difference between summed stress and rest scores was calculated. Severity was assessed using a semiquantitative scoring method from zero to four.ResultsSix of 21 (29%) subjects demonstrated reversible ischemia (summed difference score ≥3) with mental stress. No subject had chest pain or electrocardiographic changes during the stressor. Mean systolic and diastolic blood pressure and heart rate all increased between resting and times of peak stress.ConclusionsMental stress may produce ischemia in some subjects with CAD and negative exercise or chemical nuclear stress test results

Palaeogeographical evolution of the Rattray Volcanic Province, Central North Sea

Funded by Carnegie Trust for the Universities of Scotland PHD060365Peer reviewedPostprin

National Guidelines For The Management Of Pain In Older Adults

Consultation Paper- This guidance document reviews the epidemiology and management of pain in older people via a systematic literature review of published research. The aim of this document is to inform any health professionals in any care settings who work with older adults on best practice for the management of pain and to identify any gaps in the evidence which may require further research

The Decline of Remarriage: Evidence From German Village Populations in the Eighteenth and Nineteenth Centuries

Family reconstitution data for fourteen German village populations permit the examination of remarriage during the eighteenth and nineteenth cen turies. The results provide compelling evidence for a secular decline in the tenden cy to remarry. Pronounced age and sex differentials in the likelihood of remar riage were evident: widows were far less likely to remarry than widowers, and the probability of remarriage declined rapidly with age, particularly for women. The probability of remarriage was also inversely associated with the number and age of children. There were, however, no clear differences in either the probability of remarriage or its tendency to decline over time among major occupational groups. The decline in remarriage probabilities was caused in part by declines in adult mortality, which gradually raised the ages of surviving spouses to levels at which remarriage has historically been rather unlikely. However, age-specific marriage probabilities also declined, affecting both men and women and all oc cupational groups, suggesting the presence of a social change of wide scope. Some comments on possible factors contributing to the decline of remarriage are presented. The need for a comprehensive explanation of remarriage trends and differentials remains an important challenge for family historians.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68212/2/10.1177_036319908501000103.pd

Unfinished Decolonisation and Globalisation

This article locates John Darwin’s work on decolonisation within an Oxbridge tradition which portrays a British world system, of which formal empire was but one part, emerging to increasing global dominance from the early nineteenth century. In this mental universe, decolonisation was the mirror image of that expanding global power. According to this point of view, it was not the sloughing off of individual territories, but rather the shrinking away of the system and of the international norms that supported it, until only its ghost remained by the end of the 1960s. The article then asks, echoing the title of Darwin’s Unfinished Empire, whether the decolonisation project is all but complete, or still ongoing. In addition, what is the responsibility of the imperial historian to engage with, inform, or indeed refrain from, contemporary debates that relate to some of these issues? The answer is twofold. On the one hand, the toolkit that the Oxbridge tradition and Darwin provide remains relevant, and also useful in thinking about contemporary issues such as China’s move towards being a global power, the United States’ declining hegemony, and some states and groups desires to rearticulate their relationship with the global. On the other hand, the decline of world systems of power needs to be recognised as just one of several types of, and approaches to, analysing ‘decolonisation’. One which cannot be allowed to ignore or marginalise the study of others, such as experience, first nations issues, the shaping of the postcolonial state, and empire legacies. The article concludes by placing the Oxbridge tradition into a broader typology of types and methodologies of decolonisation, and by asking what a new historiography of decolonisation might look like. It suggests that it would address the Oxbridge concern with the lifecycles of systems of power and their relationship to global changes, but also place them alongside, and in dialogue with, a much broader set of perspectives and analytical approaches